WASHINGTON COUNTY HOSPITAL
705 South Grand Avenue,
Nashville, IL 62263
NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003 v 1.0
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATIONABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, or for additional information, please contact our Privacy Officer at
WHO WILL FOLLOW THIS NOTICE:
This notice describes our hospital’s practices and that of:
• Any health care professional authorized to enter information into
your hospital chart.
• All departments and units of the hospital.
• Any member of a volunteer group we allow to help you while you are
in the hospital.
• All employees, staff and other hospital personnel
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal.
We are committed to protecting medical information about you. We create
a record of the care and services you receive at the hospital. We need
this record to provide you with quality care and to comply with certain
legal requirements. This notice applies to all of the records of your
care generated by the hospital, whether made by hospital personnel
or your personal doctor. Your personal doctor may have different policies
or notices regarding the doctor’s use and disclosure of your
medical information created in the doctor’s office or clinic.
This notice will tell you about the ways in which we may use and disclose
medical information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of medical information.
We are required by law to:
• Make sure that medical information that identifies you is kept
• Give you this notice of our legal duties and privacy practices
with respect to medical information about you; and
• Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
The following categories describe different ways that we use and disclose
medical information. For each category of uses or disclosures we will
explain what we mean and try to give some examples. Not every use or
disclosure in a category will be listed. However, all of the ways we
are permitted to use and disclose information will fall within one
of these categories.
• Treatment. We may use medical information about you to provide
you with medical treatment or services. We may disclose medical information
about you to doctors, nurses, technicians, medical students, or other hospital
personnel who are involved in taking care of you at the hospital.
For example, a doctor treating you for a broken leg may need to know if
you have diabetes because diabetes may slow the healing process. In addition,
the doctor may need to tell the dietitian if you have diabetes so that
we can arrange for appropriate meals. Different departments of the hospital
also may share medical information about you in order to coordinate the
different things you need, such as prescriptions, lab work and x-rays.
We also may disclose medical information about you to people outside the
hospital who may be involved in your medical care after you leave the hospital,
such as family members, clergy or others we use to provide services that
are part of your care.
• Payment. We may use and disclose medical information about you
so that the treatment and services you receive at the hospital may be billed
to and payment may be collected from you, an insurance company or a third
For example, we may need to give your health plan information about surgery
you received at the hospital so your health plan will pay us or reimburse
you for the surgery. We may also tell your health plan about a treatment
you are going to receive to obtain prior approval or to determine whether
your plan will cover the treatment.
• Health Care Operations. We may use and disclose medical information
about you for the hospital operations. These uses and disclosures are necessary
to run the hospital and make sure that all of our patients receive quality
For example, we may use medical information to review our treatment and
services and to evaluate the performance of our staff in caring for you.
We may also combine medical information about many hospital patients to
decide what additional services the hospital should offer, what services
are not needed, and whether certain new treatments are effective. We may
also disclose information to doctors, nurses, technicians, medical students,
and other hospital personnel for review and learning purposes. We may also
combine the medical information we have with medical information from other
hospitals to compare how we are doing and see where we can make improvements
in the care and services we offer. We may remove information that identifies
you from this set of medical information so others may use it to study
health care and health care delivery without learning who the specific
• Appointment Reminders. We may use and disclose medical information
to contact you as a reminder that you have an appointment for treatment
or medical care at the hospital.
• Treatment Alternatives. We may use and disclose medical information
to tell you about or recommend possible treatment options or alternatives
that may be of interest to you.
• Health-Related Benefits and Services. We may use and disclose medical
information to tell you about health-related benefits or services that
may be of interest to you.
• Individuals Involved in Your Care or Payment for Your Care. We
may release medical information about you to a friend or family member
who is involved in your medical care. We may also give information to someone
who helps pay for your care. We may also tell your family or friends your
condition and that you are in the hospital. In addition, we may disclose
medical information about you to an entity assisting in a disaster relief
effort so that your family can be notified about your condition, status
• Research. Under certain circumstances, we may use and disclose
medical information about you for research purposes. For example, a research
project may involve comparing the health and recovery of all patients who
received one medication to those who received another, for the same condition.
All research projects, however, are subject to a special approval process.
This process evaluates a proposed research project and its use of medical
information, trying to balance the research needs with patients’ need
for privacy of their medical information. Before we use or disclose medical
information for research, the project will have been approved through this
research approval process, but we may, however, disclose medical information
about you to people preparing to conduct a research project, for example,
to help them look for patients with specific medical needs, so long as
the medical information they review does not leave the hospital. We will
almost always ask for your specific permission if the researcher will have
access to your name, address or other information that reveals who you
are, or will be involved in your care at the hospital
• As Required By Law. We will disclose medical information about
you when required to do so by federal, state or local law
• To Avert a Serious Threat to Health or Safety. We may use and disclose
medical information about you when necessary to prevent a serious threat
to your health and safety or the health and safety of the public or another
person. Any disclosure, however, would only be to someone able to help
prevent the threat.
• Organ and Tissue Donation. If you are an organ donor, we may release
medical information to organizations that handle organ procurement or organ,
eye or tissue transplantation or to an organ donation bank, as necessary
to facilitate organ or tissue donation and transplantation.
• Military and Veterans. If you are a member of the armed forces,
we may release medical information about you as required by military command
authorities. We may also release medical information about foreign military
personnel to the appropriate foreign military authority.
• Workers’ Compensation. We may release medical information
about you for workers’ compensation or similar programs. These programs
provide benefits for work-related injuries or illness.
• Public Health Risks. We may disclose medical information about
you for public health activities. These activities generally include the
• to prevent or control disease, injury or disability;
• to report births and deaths;
• to report child abuse or neglect;
• to report reactions to medications or problems with products;
• to notify people of recalls of products they may be using;
• to notify a person who may have been exposed to a disease or may
be at risk for contracting or spreading a disease or condition;
• to notify the appropriate government authority if we believe a
patient has been the victim of abuse, neglect or domestic violence. We
will only make this disclosure if you agree or when required or authorized
• Health Oversight Activities. We may disclose medical information
to a health oversight agency for activities authorized by law. These oversight
activities include, for example, audits, investigations, inspections, and
licensure. These activities are necessary for the government to monitor
the health care system, government programs, and compliance with civil
• Lawsuits and Disputes. If you are involved in a lawsuit or a dispute,
we may disclose medical information about you in response to a court or
administrative order. We may also disclose medical information about you
in response to a subpoena, discovery request, or other lawful process by
someone else involved in the dispute, but only if efforts have been made
to tell you about the request or to obtain an order protecting the information
• Law Enforcement. We may release medical information if asked to
do so by a law enforcement official
• In response to a court order, subpoena, warrant, summons or similar process;
• To identify or locate a suspect, fugitive, material witness, or missing
• About the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person’s agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at the hospital; and
• In emergency circumstances to report a crime; the location of the crime
or victims; or the identity, description or location of the person who
committed the crime.
• Coroners, Medical Examiners and Funeral Directors. We may release
medical information to a coroner or medical examiner. This may be necessary,
for example, to identify a deceased person or determine the cause of death.
We may also release medical information about patients of the hospital
to funeral directors as necessary to carry out their duties
• National Security and Intelligence Activities. We may release medical
information about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized
• Protective Services for the President and Others. We may disclose
medical information about you to authorized federal officials so they may
provide protection to the President, other authorized persons or foreign
heads of state or conduct special investigations.
• Inmates. If you are an inmate of a correctional institution or
under the custody of a law enforcement official, we may release medical
information about you to the correctional institution or law enforcement
official. This release would be necessary (1) for the institution to provide
you with health care; (2) to protect your health and safety or the health
and safety of others; or (3) for the safety and security of the correctional
OTHER USES OF MEDICAL INFORMATION:
Other uses and disclosures of medical information not covered by this notice
or the laws that apply to us will be made only with your written permission.
If you provide us permission to use or disclose medical information about
you, you may revoke that permission, in writing, at any time. If you
revoke your permission, we will no longer use or disclose medical information
about you for the reasons covered by your written authorization. You
understand that we are unable to take back any disclosures we have already
made with your permission, and that we are required to retain our records
of the care that we provided to you.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice. We reserve the right to make
the revised or changed notice effective for medical information we already
have about you as well as any information we receive in the future. We
will post a copy of the current notice in the hospital. The notice will
contain on the first page, in the top right-hand corner, the effective
date. In addition, each time you register at or are admitted to the hospital
for treatment or health care services as an inpatient or outpatient,
we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a written
complaint with the hospital or with the Secretary of the Department of
Health and Human Services. All documentation of complaints and their
disposition will be kept on file at WCH for 6 years. Complaints to the
hospital must be submitted in writing to:
HIPAA Privacy Officer
Washington County Hospital
705 South Grand Avenue
Nashville, IL 62263
You will not be penalized for filing a complaint.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we maintain
• Right to Inspect and Copy. You have the right to inspect and copy
medical information that may be used to make decisions about your care.
Usually, this includes medical and billing records, but does not include
To inspect and copy medical information that may be used to make decisions
about you, you must submit your request in writing to the Medical Records
department. If you request a copy of the information, we may charge a fee
for the costs of copying, mailing or other supplies associated with your
We may deny your request to inspect and copy in certain very limited circumstances.
If you are denied access to medical information, you may request that the
denial be reviewed. Another licensed health care professional chosen by
the hospital will review your request and the denial. The person conducting
the review will not be the person who denied your request. We will comply
with the outcome of the review.
• Right to Amend. If you feel that medical information we have about
you is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the information
is kept by or for the hospital.
To request an amendment, your request must be made in writing and submitted
to the Medical Records department. In addition, you must provide a reason
that supports your request.
• We may deny your request for an amendment if it is not in writing or
does not include a reason to support the request.
• In addition, we may deny your request if you ask us to amend information
that: Was not created by us, unless the person or entity that created the
information is no longer available to make the amendment
• Is not part of the medical information kept by or for the hospital;
• Is not part of the information which you would be permitted to inspect
and copy; or
• Is accurate and complete.
• Right to an Accounting of Disclosures. You have the right to request
an “accounting of disclosures.” This is a list of the disclosures
we made of medical information about you.
To request this list or accounting of disclosures, you must submit your
request in writing to the Medical Records department. Your request must
state a time period, which may not be longer than six years and may not
include dates before April 14, 2003. Your request should indicate in what
form you want the list (for example, on paper, electronically). The first
list you request within a 12-month period will be free. For additional
lists, we may charge you for the costs of providing the list. We will notify
you of the cost involved and you may choose to withdraw or modify your
request at that time before any costs are incurred.
• Right to Request Restrictions. You have the right to request a
restriction or limitation on the medical information we use or disclose
about you for treatment, payment or health care operations. You also have
the right to request a limit on the medical information we disclose about
you to someone who is involved in your care or the payment for your care,
like a family member or friend. For example, you could ask that we do not
use or disclose information about a surgery you had.
We are not required to agree to your request. If we do agree, we will
comply with your request unless the information is needed to provide you
To request restrictions, you must make your request in writing to the
Medical Records department. In your request you must tell us
• What information you want to limit;
• Whether you want to limit our use, disclosure or both; and
• To whom you want the limits to apply, for example, disclosures to your
• Right to Request Confidential Communications. You have the right
to request that we communicate with you about medical matters in a certain
way or at a certain location. For example, you can ask that we only contact
you at work or by mail.
To request confidential communications, you must make your request in
writing to the Medical Records department. We will not ask you the reason
for your request. We will accommodate all reasonable requests. Your request
must specify how or where you wish to be contacted.
• Right to a Paper Copy of This Notice. You have the right to a paper
copy of this notice. You may ask us to give you a copy of this notice at